Oral Nano Vitamin D Supplementation Reduces Disease Activity in Ulcerative Colitis

Abstract

Introduction: Vitamin D possesses anti-inflammatory properties and could be beneficial in ulcerative colitis (UC). Methods: We studied the effect of oral nano vitamin D3 supplementation on disease activity in active UC [ulcerative colitis disease activity index (UCDAI)≥3]. Patients with active UC and vitamin D <40 ng/mL were randomized to receive either oral nano vitamin D (60,000 IU/d×8 d) or placebo. They were evaluated for disease activity (UCDAI scores, C-reactive protein, erythrocyte sedimentation rate, and fecal calprotectin) at baseline and reassessed at 4 weeks. The response was defined as a 3-point reduction in UCDAI score at 4 weeks and reduction in inflammatory markers. Results: The median vitamin D levels increased from 15.4 to 40.83 mg/dL in vitamin D group (P≤0.001) and marginally from 13.45 to 18.85 mg/dL (P=0.027) in controls. The 3-point reduction in UCDAI was seen more often in vitamin D group as compared with the control (53% vs. 13%; P=0.001). Increase in vitamin D levels correlated with reduction in UCDAI score (P≤0.001; ρ=−0.713), C-reactive protein (P≤0.001; ρ=−0.603), and calprotectin (P=0.004; ρ=−0.368). Patients who achieved target vitamin D of >40 ng/mL (n=17) more often had a 3-point reduction in UCDAI (80% vs. 20%; P≤0.001) and reduction in grade of severity from 60% to 35% (P=0.038). Vitamin D administration (odds ratio, 9.17; 95% confidence interval, 2.02-41.67) and baseline histologic activity (odds ratio, 1.92; 95% confidence intervals, 1.2-3.08) independently predicted response. Conclusions: Oral nano vitamin D supplementation in active UC is associated with a reduction in disease activity and severity grade and is seen more often in those who achieved a target vitamin D level of 40 ng/mL.

Vitamin D intake is associated with decreased risk of immune checkpoint inhibitor‐induced colitis

“…In conclusion, here we report that patients taking vitamin D at the time their first ICI treatment was initiated had significantly reduced odds of developing ICI colitis over the course of their immunotherapy regimen. These results may suggest benefit in prophylactic use of vitamin D supplementation to prevent ICI colitis, as previously demonstrated in inflammatory bowel disease [56][57][58][59]65,66 and graft-versus-host disease. 49,67,68 Cancer August 15, 2020…”

“…55 There is growing evidence that vitamin D supplementation reduces disease severity and risk of relapse in IBD patients. [56][57][58][59] In the multivariable regression model of our discovery cohort, we also found that elevated baseline NLR ≥ 5 was negatively correlated with risk of developing ICI colitis. This finding is similar to that of a recent study in South Korea reporting lower risk of irAEs in patients with baseline NLR ≥ 3 who were treated with pembrolizumab, although this study did not examine colitis specifically.…”

“…In conclusion, here we report that patients taking vitamin D at the time their first ICI treatment was initiated had significantly reduced odds of developing ICI colitis over the course of their immunotherapy regimen. These results may suggest benefit in prophylactic use of vitamin D supplementation to prevent ICI colitis, as previously demonstrated in inflammatory bowel disease 56‐59,65,66 and graft‐versus‐host disease 49,67,68 . The specific mechanism by which vitamin D may prevent immune‐related colitis should be further explored through future correlative studies, including cytokine analyses and immune profiling at baseline and at the time of colitis.…”

“…Polymorphisms in the VDR gene are also associated with susceptibility to inflammatory bowel disease 55 . There is growing evidence that vitamin D supplementation reduces disease severity and risk of relapse in IBD patients 56‐59 …”

Therapeutic effects of vitamin D on acetic acid-induced colitis in rats

“…In many epidemiological studies, it is stated that there is a relationship between vitamin D3 levels and the life quality of IBD patients 22 . It has been observed that supplementing vitamin D in patients with active UC with low level of vitamin D decreases the clinical activity of the disease, decreases the levels of inflammation markers and improves histopathological alterations 24 . Vitamin D plays a role in cell proliferation and differentiation, as well as immunomodulation 25,26 .…”